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Surgery Shelf Study Guide > Subspecialty Surgery > Flashcards

Subspecialty Surgery Flashcards

0
Q

How does esophageal atresia present?

A

Presents as excess salivation, choking spells, coiling NG tube, and often a TE fistula
Tx surgical repair

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1
Q

What is VACTERL syndrome?

A 
Vertebral
Anal atresia
Cardiac 
TracheoEsophageal fistula
Esophageal atresia
Renal 
Limbs (radius)
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2
Q

How do you manage anal atresia?

A

High rectal pouch –> colostomy then delayed repair, low rectal pouch –> repair, if anofistula present –> delay repair since further growth may correct condition

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3
Q

How does a congenital diaphragmatic hernia present?

A

Presents as RDS due to hypoplastic left lung

Dx: CXR shows bowel in left chest, tx intubation with low pressure ventilation

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4
Q

What is gastroschisis?

A

midline hernia to left of umbilical cord tearing through peritoneum
tx: closure if small, silo if large, and TPN for a month since GI doesn’t work

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5
Q

What is an omphalocele?

A

Midline hernia through the cord with peritoneal covering; tx closure if small, silo if large

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6
Q

What does biliary vomiting indicate?

A

Indicates SBO distal to ampulla of Vater; DDx duodenal atresia, intestinal atresia, annular pancreas, or malrotation

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7
Q

How does malrotation present?

A

Presents as biliary vomiting and double-bubble on X ray; dx contrast enema or upper GI study, tx emergency surgical correction

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8
Q

How does intestinal atresia present?

A

Presents as biliary vomiting and multiple air-fluid levels on X-ray, aka apple-peel atresia due to vascular accident in utero

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9
Q

How does necrotizing enterocolitis present?

A

Presents as feeding intolerance, abd distention, and decreased platelets in premies; tx NPO, IVF, TPN, IV abx –> surgical repair if signs of intestinal necrosis/perforation present

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10
Q

How does pyloric stenosis present?

A

Presents as non-bilious projectile vomiting in first-born boys; dx palpable epigastric olive tx rehydration and pyloromyotomy

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11
Q

How does biliary atresia present?

A

Presents as progressive jaundice in a 1-2 month old due to lack of CBD; Dx HIDA scan + phenobarbital (to stimulate GB contraction), Tx liver transplant

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12
Q

How does Hirschsprung’s disease present?

A

Presents as chronic constipation due to lack of nerves in distal colon, rectal exam can decompress bowel; dx X ray shows distended proximal colon, tx surgical pull-through

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13
Q

How does intussusception present?

A

Presents as colicky abd pain that lasts 1 minute then resolves, and currant jelly stools; dx/tx barium or air enema

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14
Q

How does child abuse present?

A

Presents as retinal hemorrhages, SDH, multiple healed fx, and scalding burns; call child protective services

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15
Q

How does Meckel’s diverticulum present?

A

Presents as LGIB in a child, dx technetium uptake for ectopic gastric mucosa

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16
Q

How do vascular rings present?

A

Stridor, RDS, crowing respiration, and dysphagia in an infant due to compression of trachea and esophagus; dx barium swallow and bronchoscopy, tx surgical correction

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17
Q

How does an ASD present?

A

Presents as low-grade systolic murmur, fixed S2, and frequent colds; dx echo, tx surgery

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18
Q

How does a VSD present?

A

Presents as pansystolic harsh-sounding murmur with failure to thrive; dx echo, tx surgery

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19
Q

How does a PDA present?

A

Presents with machinery-like murmur, often seen with congenital rubella syndrome; dx echo, tx indomethacin or surgery

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20
Q

How does Tetralogy of Fallot present?

A

Presents as cyanosis and clubbing in a five y/o child who squats for relief; px determined by degree of pulmonary stenosis, dx echo shows RVH, tx surgery

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21
Q

How does transposition of the great vessels present?

A

Presents as life-threatening cyanosis in a newborn; dx echo, tx surgery

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22
Q

What is strabismus?

A

Misaligned eyes due to uncoordinated extraocular muscles; tx surgical extraocular muscle manipulation to prevent ambylopia

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23
Q

What is amblyopia?

A

Vision impairment usually due to strabismus in kids

tx eyepatch the good eye to develop the impaired one

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24
Q

How does retinoblastoma present?

A

Presents as a leukocoria in a baby

Tx surgical enucleation

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25
Q

How does retinal detachment present?

A

Presents as flashes and floaters, and a dark curtain being pulled down over the eye; tx emergency laser “spot welding”

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26
Q

What is amaurosis fugax?

A

Emboli from carotid travels to retina causing transient blindness
dx fundoscopic exam reveals hollenhorst plaque, a bright shiny spot in a retinal artery

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27
Q

How does an embolic occlusion of the renal artery present?

A

Presents as a sudden unilateral loss of vision; tx breathe into paper bag and repeatedly press on eye to shake clot into a more distal branch of retinal artery

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28
Q

What is a tyroglossal duct cyst?

A

Remnant of thyroglossal duct as a mobile midline neck mass
Dx at 1-2 years old due to neck fat
Tx Sistrunk operation (take out cyst, trunk, and medial portion of hyoid bone)

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29
Q

What is a branchial cleft cyst?

A

Lateral mass at anterior edge of SCM, may have a small opening and blind tract

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30
Q

What is a cystic hygroma?

A

Dilated lymphatic duct at base of neck, common in Turner syndrome, get CT scan to find extent of mass before surgical removal

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31
Q

How do lymphomas present?

A

Present with multiple swollen LN, fever, and night sweats; get excisional biopsy then Tx chemo

32
Q

How does head/neck SCC present?

A

Presents as persistent hoarseness, painless ulcer in the floor of mouth, or unilateral earache; risk factors are EtOH, smoking, and AIDS

33
Q

How do you manage SCC of the head/neck?

A

Get triple endoscopy to look for primary tumor–> biopsy tumor–> CT scan to determine stage; tx resection, radical neck dissection, cisplatin-based chemo

34
Q

How does an acoustic neuroma present?

A

presents as unilateral deafness due to Schwann cell proliferation on CN VIII

35
Q

How does a facial nerve tumor present?

A

Presents as gradual-onset unilateral facial paralysis (sudden-onset Bell’s palsy)

36
Q

How does a parotid tumor present?

A

Masses around angle of mandible, two types– pleomorphic adenomas (benign, painless) and mucoepidermoid carcinomas (malignant, painful)
Get a FNA or formal superficial parotidectomy

37
Q

What is Ludwig angina?

A

Abscess in floor of mouth due to tooth infection, tx is I and D and tracheostomy

38
Q

How does cavernous sinus thrombosis present?

A

Presents as diplopia in a patient with sinusitis due to nerve injury
tx with antibiotics, CT scan, and drainage of abscess

39
Q

What do you think of when you see epistaxis in teens? In the elderly?

A

Teens: either cocaine abuse and septal perforation (requires packing) or juvenile nasopharyngeal angiofibroma (surgical resection)
Elderly: due to HTN; requires packing, BP control, and often surgical ligation of vessels

40
Q

How is vertigo due to the inner ear different from vertigo due to the brain?

A

Inner ear: “room is spinning” tx meclizine, phenergan, or diazepam
Brain: “patient is spinning, room is stable”, do a neuro workup

41
Q

What is a TIA?

A

Brief neurologic deficit that fully resolves within 24 hours; due to thromboembolus from internal carotid arteries
Manage with carotid duplex, then aspirin and elective CEA

42
Q

What is an ischemic stroke?

A

A neurologic deficit that doesn’t resolve within 24 hours due to thromboembolus from internal carotid arteries
Tx t-PA within three hours, otherwise observe and rehab

43
Q

What is a hemorrhagic stroke?

A

Severe headache and neurologic deficit that doesn’t resolve within 24 hours in uncontrolled HTN; Dx CT scan, Tx rehab and control of HTN

44
Q

What is a SAH?

A

“Worst headache of my life” due to rupture of Charcot-Bouchard aneurysm in lenticulostriate arteries
dx: CT scan to confirm SAH, then arteriogram to locate aneurysm, the surgical clipping

45
Q

How does a CNS abscess present?

A

Presents as space-occupying lesions but short onset (weeks) with nearby infections (otitis media, mastoiditis); get CT scan then resect

46
Q

How do CNS tumors present?

A

Presents as space-occupying lesions and progressive headache over months; get MRI then resect (give mannitol, hyperventilate, and high-dose steroids while waiting)

47
Q

How do frontal lobe tumors present?

A

Present as disinhibition, anosmia (CNI), ipsilateral blindness (CNII), and contralateral papilledema

48
Q

How does a prolactinoma present?

A

Presents as amenorrhea and galactorrhea in a young woman, consider possibility of MEN1 syndrome, tx with bromocriptine

49
Q

How does a craniopharyngioma present?

A

Presents as GH deficit and bitemporal hemianopsia in a kid

Dx calcified sella turcica

50
Q

How does acromegaly present?

A

Presents as huge hands, feet, tongue, and jaws in a tall man due to increase in GH; dx get somatomedin C levels and MRI, then resection

51
Q

How does Nelson syndrome present?

A

Presents as bitemporal hemianopsia and hyperpigmentation in an adult due to pituitary microadenomas that grew to full size; dx MRI then Tx surgical resection

52
Q

How does pituitary apoplexy present?

A

Presents with typical pituitary adenoma sx, then sudden onset headache and CNS sx due to bleeding into tumor; dx MRI then emergent steroid replacement

53
Q

How does a pinealoma present?

A

Presents as loss of upper gaze and “sunset eyes” due to compression of vertical gaze center in superior colliculi

54
Q

How do spinal cord tumors present?

A

Present as back pain in someone who has been treated for other cancers
Dx MRI
Tx neurosurgical decompression

55
Q

How do brain tumors in kids present?

A

Present as cerebellar sx and headaches relieved by knee-chest position
Due to posterior fossa lesions
Dx MRI, Tx resection

56
Q

How does a neurogenic claudication present?

A

Presents with pain on exertion and relief with rest, but pain is position-dependent and pulses are intact; dx MRI tx neurosurgical decompression

57
Q

How does a trigeminal neuralgia present?

A

Severe facial pain lasting 60 seconds; dx MRI to rule out organic cause, then tx with anti-convulsants (radiofrequency ablation as backup)

58
Q

How does reflex sympathetic dystrophy present?

A

Presents as severe pain months after a crush injury with sympathetic overload
Dx sympathetic block
Tx sympathectomy

59
Q

How does testicular torsion present?

A

Presents as severe testicular pain and “high riding testicle with horizontal lie” due to twisting of the cord; tx emergent surgical detorsion, then orchiopexy

60
Q

How does epididymitis present?

A

Presents like testicular torsion but with fever, pyuria, and cord is also tender; dx U/S to rule out torsion, then antibiotics

61
Q

How does an obstructive UTI present?

A

Presents as sepsis (fever, chills, flank pain) in someone passing a kidney stone; surgical emergency that requires immediate decompression (stent or perc nephrostomy) in addition to IV antibiotics

62
Q

How does prostatitis present?

A

Presents as fever, chills, dysuria, back pain, and tender prostate on rectal exam; give antibiotics and don’t do any more rectal exams

63
Q

How do posterior urethral valves present?

A

Present as anuria in a newborn boy; catheterize to empty bladder, then dx voiding cystourethrogram
tx resection

64
Q

How does hypospadias present?

A

Presents as urethral opening on ventral side of penis, never circumcise since prepuce is needed for surgical correction

65
Q

What is epispadias?

A

Urethral opening is on the dorsal penis

66
Q

How does VUR present?

A

Presents as dysuria, fever, chills, and flank pain in kids due to ascending UTI; give antibiotics and dx IV pyelo and voiding cystogram to look for reflux
longterm abx until child “grows out of it”

67
Q

How does a low implantation of the ureter present?

A

Asymptomatic in boys, “wet with urine all the time” in girls because ureter drips into vagina instead of bladder
dx PE or IV pyelo

68
Q

How does a uteropelvic obstruction present?

A

Usually asymptomatic, but presents with colicky pain with large diuresis

69
Q

What are the urologic cancers?

A

renal cell carcinoma: hematuria, flank mass/pain, and paraneoplastic syndromes (PAPER– PTHrP, ACTH, prolactin, EPO, renin)
bladder transitional cell carcinoma: presents as painless hematuria in smokers; get IV pyelo and cystoscopy, high rate of local recurrence
prostatic cancer: asymptomatic, rock-hard nodule on rectal exam; get U/S guided needle biopsy then TURP or radiation therapy

70
Q

How does testicular cancer present?

A

Presents as painless testicular mass that doesn’t transilluminate; get radical orchiectomy with biopsy, then f/u with aFP or BHCG for recurrence
tx cisplatin or radiation if metastatic

71
Q

How does BPH present?

A

presents as dribbling, nocturia, and difficulty voiding in an old man; put in Foley for three days, and tx with alpha blockers, 5aR blockers +/- surgical resection

72
Q

How does stress incontinence present?

A

Presents as urine leaking with abdominal pressure due to weakened pelvic floor in a multigravid woman; tx surgical repair of pelvic floor

73
Q

How do kidney stones present?

A

Presents as colicky flank pain and hematuria +/- radiation to the inner thigh
Dx plain X rays
Tx analgesics, fluids, and observation

74
Q

What is the only contraindication to a transplant donor?

A

HIV status (unless donating to an HIV patient)

75
Q

What is hyperacute rejection?

A

Performed ab’s against donor organ causes vascular thrombosis within minutes; never seen since type-and-cross prevents this from happening

76
Q

What is acute rejection?

A

HLA mismatch causes macrophage attack on donor tissue with lymphocytic infiltrate, confirmed by biopsy

77
Q

What are the signs of liver rejection?

A

Indicated by elevated LFTs, first step is to get U/S and Doppler to rule out biliary obstruction and vascular thrombosis

78
Q

What is chronic rejection?

A

Gradual deterioration of organ function due to polymorphisms, irreversible and no tx available

Surgery Shelf Study Guide (13 decks)

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